Auranofin and Penicillamine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Penicillamine
Auranofin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased bone marrow depression, rash
Interaction Deep Dive
The safety of concomitant use of auranofin and penicillamine has not been established1. Concomitant gold and penicillamine therapy are reported to result in increased rashes and bone marrow depression. Gold binds to connective tissues and may remain there long after the treatment has stopped. Penicillamine can release gold from the tissues and has been used in the treatment of gold toxicity. Monitor more closely for increased toxicity with concomitant use 2.
Why it happens (mechanism)
Unknown
Literature reports
3 reports — tap to read
a) Toxic effects were reported in 114 patients who had been treated with penicillamine (75 of these had previously received gold therapy for rheumatoid arthritis). The gold was stopped either because of side effects or poor therapeutic response. Their results indicated that rashes and marrow depression were twice as common in the gold-treated group, although some of these side effects attributed to penicillamine in the gold-treated group may be due to the gold itself. Gold binds to connective tissues and may remain there long after the treatment has stopped. Penicillamine can release gold from the tissues and has been used in the treatment of gold toxicity. During treatment with penicillamine (which in most cases was started within 1 year after stopping the gold treatment), 50 patients developed 68 adverse effects. Marrow depression occurred on 9 occasions and rash developed in 19 patients. During the first 9 months of treatment 10 rashes occurred; the others after the ninth month. Improvement was noticed in 56 patients. Incidence of all side effects was the same in both groups, but marrow depression and rashes occurred more commonly in patients receiving gold therapy. Of 15 gold-treated patients who developed a rash with penicillamine, 7 had a rash while on gold. It has been previously reported that in 1 group of 17 patients with advanced RA, 14 did not respond to gold but improved with penicillamine. Their results suggest that rashes and possibly marrow depression may be more common in patients who have been on gold therapy and later treated with penicillamine 2.
b) Penicillamine-induced myasthenia has been reported to recur during gold therapy 3.
c) Previous gold therapy has been reported to have no influence on penicillamine adverse reactions 4 but another report suggests that patients who developed proteinuria or bone marrow depression during gold therapy may have an increased risk of similar adverse reactions during penicillamine therapy 5.
Common questions
Can I take Auranofin and Penicillamine together?
Increased bone marrow depression, rash Always confirm with your pharmacist or prescriber before making any change.
How serious is the Auranofin and Penicillamine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Auranofin or Penicillamine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: RIDAURA(R) oral capsules, auranofin oral capsules. Sebela Pharmaceuticals Inc (per DailyMed), Roswell, GA, 2017. DailyMed
- Webley M & Coomes EN: Is penicillamine therapy in rheumatoid arthritis influenced by previous treatment with gold?. Br Med J 1978; 2:91. PubMed
- Moore AP, Williams AC, & Hillenbrand P: Penicillamine induced myasthenia reactivated by gold. Br Med J 1984; 288:192-193. DOI
- Kean WF, Lock CJ, Howard-Lock HE, et al: Prior gold therapy does not influence the adverse effects of d-penicillamine in rheumatoid arthritis. Arthritis Rheum 1982; 25:917-922. PubMed
- Smith PJ, Swinburn OR, Swinson DR, et al: Influence of previous gold toxicity on subsequent development of penicillamine toxicity. Br Med J 1982; 285:595. DOI
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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